Tucker Park Crossing Of Journey Llc

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

eating.Interview on 01/28/2026 at 1:42 pm with LPN DD revealed she did ask residents to leave the dining area so that it didn't look like a dignity issue. LPN DD revealed some families did not understand. She further stated she didn't feel that it infringed on the rights of Resident R38 because the resident didn't know. LPN DD further revealed the resident had some dementia and memory issues but she would explore more to make sure it didn't infringe on the resident's rights.Interview on 01/30/2026 at 10:00 AM with the Director of Nursing (DON) revealed that it was not ok for staff to ask residents to leave a preferred space if that was where they wanted to be at the moment. If that was where they wanted to be, then they should be allowed to stay there. The DON further revealed she felt that it was a dignity issue for the resident to be asked to go to their room. She further stated it was Resident R38's right to be there and it was an issue. The DON revealed Resident R38 could have a negative effect of possibly isolating the resident in what was her home and it could be embarrassing to the point of where she would not come out of her room.Interview on 01/30/2026 at 5:47 PM with the Administrator revealed dignity and respect was all residents were treated with dignity and respect and if not treated with dignity and respect, people tended to respond more negatively if not treated that way.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Meadowbrook Health and Rehab

4608 Lawrenceville Highway Tucker, GA 30084

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

further revealed he suspected she went out of an alternate door that was on the side by the activities area because it was easier and there was a ramp she could have gone down. He then ran to tell the RN he was going to the street to check for the resident. He ran to the street by the road while looking both ways and noticed Resident R62. She was cross five lanes of traffic [and was continuing to walk] about 4 or 5 houses down from

the house that you see when you look directly out of the door [from the facility]. Once he saw her, he ran down towards Resident R62 to make sure she was safe. Resident R62 was not willing to walk back so he stayed in place until assistance arrived. He was not able to look at the time. He revealed she was not upset but she was not wanting to come back to the facility. He stated she came back to the facility and was still attempting to get out again [later that day] which was normal. Stated the doors had not been locked when he made it back to

the facility around 10:15-10:30 AM and was instructed to stand by the doors but could not remember who told him to do that but the Unit Manager and the DON were present on the hall. When asked about the resident, he stated she exit sought daily and constantly was going to the doors shaking on them. He further stated her bags were always packed and at the door.

Interview on 01/30/2026 at 2:38 PM with the DON revealed the sprinkler system was being serviced and was not supposed to trip the electrical system [power]. Stated the care plan was updated that same day to include a wanderguard since Resident R62 did not have an elopement prior to 12/30/2026.

Interview on 01/30/2026 at 5:47 PM with the Administrator revealed he was not onsite from when he received the call of the elopement, the staff had already noticed that Resident R62 was gone, and they had gone out and received the message they had located her outside. At that time, apparently the sprinkler guys were there, and all the doors were open and they [all staff] had started fire watch on the doors. The Maintenance Assistant was put on the line/phone and once the sprinkler technician realized the problem (when the facility called the code), another supervisor from the sprinkler company did the test wrong, which had never happened before.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Meadowbrook Health and Rehab

4608 Lawrenceville Highway Tucker, GA 30084

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0759 Level of Harm - Minimal harm or potential for actual harm

to ensure proper delivery, as failing to do so may result in administering air and improper absorption. If a medication was given outside the physician's parameters, nurses were expected to assess the resident, monitor blood pressure, notify the physician, and document all actions, since deviations could result in the resident's blood pressure dropping dangerously low.

Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Meadowbrook Health and Rehab

4608 Lawrenceville Highway Tucker, GA 30084

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0761

residents and potential side effects are unknown.

Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Meadowbrook Health and Rehab

4608 Lawrenceville Highway Tucker, GA 30084

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many

1. 3. During observation with Resident R18 on 1/27/2026 at 1:06 PM, it was revealed that Resident R18 was on 3 liters of oxygen

(O2). The O2 machine had fuzzy, thick, and dry gray particles on the filter on the back of machine. Resident R18 also stated that the tubing for the O2 machine got changed once a week and she hadn't seen a Respiratory Therapist (RT).

Observation on 01/28/2026 at 1:24 PM revealed that Resident R18 had just finished ADL (activities of daily living) care and was lying in bed with a night gown on. The air filter on the back of the O2 machine was covered with fuzzy, thick, and dry gray particles.

Observation on 01/30/2026 at 8:19 AM revealed Resident R18 was sitting up in bed eating breakfast and watching television. The air filter on the back of the O2 machine was covered with fuzzy, thick, and dry gray particles.

Interview with Certified Nursing Assistant (CNA) NN on 01/27/2026 at 02:16 PM revealed that the nurses handled O2 machines.

Interview with RN CC on 01/28/2026 at 2:24 PM revealed that tubing for O2 machines was replaced on the night shift and that she was not sure how often the tubes were replaced. RN CC also stated that RT was supposed to clean filters every day and was last here Monday, 01/26/2026 and Tuesday, 01/27/2026.

Interview with Unit Manager AA on 01/30/2026 at 8:39 AM revealed she didn't know who was supposed to clean the O2 machine filters, ensure that a resident had a filter, or how often the filters were to be cleaned.

Interview with DON on 01/30/2026 at 9:28 AM revealed that the RT was supposed to follow up on all residents that were on O2.

FORM CMS-2567 (02/99) Previous Versions Obsolete

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

01/30/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Meadowbrook Health and Rehab

4608 Lawrenceville Highway Tucker, GA 30084

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and

the public.

Based on observations and staff interviews, the facility failed to provide a safe, functional, sanitary environment for residents, staff, and the public by not cleaning the Packaged Terminal Air Conditioner (PTAC) filter in six rooms (Room D-16, Room D-12, Room D-15, Room E-52, Room D-15, and Room E41)

on five of five halls sampled. This deficient practice had the potential to cause respiratory irritation and exacerbation of conditions in residents with chronic obstructive pulmonary disease and other related lung diseases.Findings include:Observation on 01/27/2026 at 11:45 AM in room D16 revealed that the PTAC unit had two filters, and both filters observed to have a grey fuzzy substance approximately 1/8 inch thick, covering the filter.Observation on 01/27/2026 at 12:00 PM of resident rooms D12 and D15 revealed that both PTAC units in these rooms had 2 filters, and both filters in each unit were covered with a grey fuzzy substance that made the filters opaque.Observation on 01/27/2026 at 12:17 PM of resident room E52 revealed that both filters in the PTAC unit were covered with a grey fuzzy substance that made the filters opaque.Observation on 01/27/2026 at 02:06 PM revealed that room D15's PTSC filters still had a fuzzy grey substance on the two filters.Observation on 01/27/2026 at 02:10 PM revealed the PTAC filters in room E41 had a grey fuzzy substance on both filters.Observation on 01/28/2026 at 02:24 PM revealed that the PTAC filters in rooms D16, D12, D15, and E41 had a grey fuzzy substance on them that made the filter opaque. Observation and interview on 01/28/2026 at 05:00 PM during a walk-through with the Maintenance Director revealed that all PTAC units in the building, including B, C, E, A, and D halls, required cleaning.

Event ID:

Facility ID:

If continuation sheet